Efficacy and safety of first-line treatment for metastatic triple-negative breast cancer: A network meta-analysis

This network meta-analysis, published in Cancer Pathogenesis and Therapy 2 (2024): 81–90, systematically evaluates first-line therapeutic regimens for metastatic triple-negative breast cancer (mTNBC) by synthesizing data from 29 randomized controlled trials (RCTs) involving 4,607 patients, with regimen efficacy ranked via the surface under the cumulative ranking curve (SUCRA).

Key findings: Cisplatin combined with nab-paclitaxel or paclitaxel outperforms docetaxel plus capecitabine in progression-free survival (PFS; HR=0.43, 95% CI: 0.24–0.77 for cisplatin + nab-paclitaxel; HR=0.29, 95% CI: 0.14–0.59 for cisplatin + paclitaxel) and objective response rate (ORR), establishing these platinum-based combinations as preferred first-line options for unselected mTNBC. For biomarker-defined subgroups, atezolizumab/pembrolizumab plus nab-paclitaxel benefits PD-L1-positive mTNBC, while talazoparib improves PFS in BRCA-mutated cases (HR=0.33, 95% CI: 0.11–0.96). No significant overall survival (OS) differences were observed across regimens. Severe adverse events primarily included neutropenia, diarrhea, and fatigue, with platinum-containing regimens associated with higher thrombocytopenia risk.

Its innovation lies in integrating direct/indirect comparison data and biomarker-stratified analyses. Clinically, it guides personalized therapy: platinum-based combinations for general mTNBC, immunotherapy-chemotherapy for PD-L1 positivity, and PARP inhibitors for BRCA mutations. It also emphasizes targeted toxicity management, thereby informing evidence-based clinical decision-making for mTNBC.